Patel RM, Rose AT, Neves S
… +21 more, Giacinto R, Perez S, Kim J, Martin CR, Good M, Yanowitz T, Profit J, Scottoline B, Markel TA, Spruce M, Hair A, Underwood M, Quinn J, Rosito S, Pryor E, Vernon L, Mebane A, Green L, Umberger E, Canvasser J, NEC Society Patient-Centered Outcomes Research Leadership Team
BACKGROUND: Necrotizing enterocolitis (NEC) research priorities informed by a broad group of stakeholders have not been previously determined. METHODS: We recruited 11 patient-families and 11 clinician-researchers to dev...BACKGROUND: Necrotizing enterocolitis (NEC) research priorities informed by a broad group of stakeholders have not been previously determined. METHODS: We recruited 11 patient-families and 11 clinician-researchers to develop a prioritized research agenda from 11/19 to 8/22. We identified topics to prioritize through a systematic literature review, analysis of patient stories, and an open-ended survey, and prioritized these in a two-round Delphi process. RESULTS: We identified and consolidated 157 potential topics from 1754 research articles, 236 patient-family stories, and 10 survey themes, focusing on patient-centered or comparative effectiveness research. The top 6 priorities were: (1) Medications and treatment to prevent NEC; (2) Human milk and lactation support; (3) Tools for diagnosing NEC; (4) Acute management of NEC; (5) Patient-family engagement; (6) Long-term gastrointestinal outcomes. CONCLUSIONS: The top 6 research topics, identified collaboratively through patient-family and clinician-researcher partnerships, should be prioritized by scientists, administrators, funders, policymakers, and others to accelerate research meaningful to NEC stakeholders.
OBJECTIVE: To evaluate the effects of prophylactic hydrocortisone (pHCT) on the odds of death or moderate to severe bronchopulmonary dysplasia (BPD) in preterm neonates. STUDY DESIGN: Multi-center retrospective cohort st...OBJECTIVE: To evaluate the effects of prophylactic hydrocortisone (pHCT) on the odds of death or moderate to severe bronchopulmonary dysplasia (BPD) in preterm neonates. STUDY DESIGN: Multi-center retrospective cohort study of infants born <28 weeks in the Canadian Neonatal Network 2019-2023 who received pHCT with 1:1 propensity score-matched controls. Hierarchical composite endpoints were explored using win odds analyses. RESULTS: There were 361 infants per group with balanced baseline characteristics. There were no differences in the odds of death or moderate to severe BPD (pHCT 259/361 [71.8%] vs. control 264/361 [73.1%], OR 0.92, 95% CI [0.68, 1.24]). Win odds (95% CI) were not different: 1.02 (0.85, 1.28). There was lower use of systemic postnatal steroids and treatment of patent ductus arteriosus in the pHCT group; no significant differences in other safety outcomes were observed. CONCLUSIONS: pHCT was not associated with reductions in mortality nor moderate to severe BPD.
OBJECTIVE: This study compares the Finnegan Score and NASSCORES for assessing neonatal abstinence syndrome (NAS), focusing on interrater reliability (IRR), accuracy, and provider preference. STUDY DESIGN: This prospectiv...OBJECTIVE: This study compares the Finnegan Score and NASSCORES for assessing neonatal abstinence syndrome (NAS), focusing on interrater reliability (IRR), accuracy, and provider preference. STUDY DESIGN: This prospective study involved 75 neonatal providers who assessed two standardized videos of newborns with NAS using both the Finnegan score and NASSCORES. Participants scored each video with both tools and completed a Likert-based preference survey. Intraclass correlation coefficient ICC(2,1) was used to measure IRR. RESULT: NASSCORES showed a higher IRR compared with the Finnegan score and greater scoring accuracy for both videos. Most neonatal providers favored NASSCORES for faster computation, easier use, better treatment guidance, and overall satisfaction, with fewer concerns about its clinical utility. CONCLUSION: NASSCORES outperformed Finnegan Score in this standardized video study, indicating its potential as a more practical scoring tool for NAS. Further validation in clinical settings is recommended.
Advances in fetal diagnosis and therapy have created a need for clinicians with expertise spanning prenatal assessment and neonatal care. Current maternal fetal medicine and neonatology training pathways remain largely s...Advances in fetal diagnosis and therapy have created a need for clinicians with expertise spanning prenatal assessment and neonatal care. Current maternal fetal medicine and neonatology training pathways remain largely separate, leaving gaps in knowledge of placental pathology, fetal surveillance, antenatal interventions, and their neonatal consequences. We propose a fetoneonatology fellowship for graduates of neonatal and potentially obstetric residency programs at academic centers with maternal fetal medicine services, Level IV neonatal intensive care units, and placental pathology expertise. The three-year curriculum would include one year of fetal medicine and placental biology and two years of neonatal intensive care training integrated through a Fetal Neonatal Bridge Curriculum. An optional advanced track would emphasize continuity care, research, and artificial intelligence-supported practice. This model aims to improve prenatal neonatal correlation, trainee preparedness, and family communication, and could evolve from a super fellowship into an accredited subspecialty.
OBJECTIVE: Evaluate surfactant therapy and clinical outcomes including length of hospital stay (LOS), CPAP, and mechanical ventilation in late preterm to early term infants. STUDY DESIGN: A single-center retrospective st...OBJECTIVE: Evaluate surfactant therapy and clinical outcomes including length of hospital stay (LOS), CPAP, and mechanical ventilation in late preterm to early term infants. STUDY DESIGN: A single-center retrospective study of 401 eligible infants 33-38 + 6 weeks. Surfactant administration included INSURE (INtubation-SURfactant-Extubation), LISA (Less Invasive Surfactant Administration), and endotracheal with prolonged invasive ventilation. RESULTS: 114 (28%) received surfactant. Surfactant-treated infants had longer LOS (16 ± 11 vs 12 ± 9 days, p < 0.001) compared to non-treated. Infants who received INSURE/LISA (n = 43) had shorter LOS (14 ± 9 vs 18 ± 12 days, p = 0.04) than endotracheal surfactant with prolonged mechanical ventilation (n = 71). Infants who received INSURE/LISA had similar LOS to non-surfactant-treated infants (14 ± 9 vs 13 ± 9 days, p = 0.47). CONCLUSION: Surfactant administration was associated with longer hospitalization compared to non-treated infants. INSURE/LISA shortened LOS compared to surfactant with prolonged ventilation. In late preterm and early term infants that require surfactant for RDS, less invasive methods reduce LOS.
The field of neonatology is currently navigating a multi-faceted crisis involving professional identity, workforce sustainability, and financial equity. While the Neonatal Intensive Care Unit (NICU) serves as a vital eco...The field of neonatology is currently navigating a multi-faceted crisis involving professional identity, workforce sustainability, and financial equity. While the Neonatal Intensive Care Unit (NICU) serves as a vital economic engine for modern health systems and academic departments, the individual neonatologist faces increasing clinical acuity, documentation burdens, long work hours, and a widening compensation gap compared to adult counterparts. This manuscript explores the "Neonatology Paradox," as a specialty with the highest productivity in a financially challenged department of pediatrics. We also evaluate the limitations of current productivity benchmarks and propose structural changes, including staffing model changes to optimize work hours, reduce productivity expectations, and work life integration. If these measures fail, we explore the potential for an independent department of Neonatal Critical Care to ensure the future of the workforce.
OBJECTIVE: Metabolic Bone Disease of Prematurity (MBDP) results from disrupted third-trimester mineral accretion in preterm neonates, leading to inadequate bone mineralization. Despite adherence to standard nutritional g...OBJECTIVE: Metabolic Bone Disease of Prematurity (MBDP) results from disrupted third-trimester mineral accretion in preterm neonates, leading to inadequate bone mineralization. Despite adherence to standard nutritional guidelines, MBDP remains common. This systematic review assesses the effectiveness of nutritional supplementation and physiotherapy in reducing MBDP incidence and severity. STUDY DESIGN: The review was conducted under PRISMA guidelines and registered with PROSPERO. We retrieved 942 studies from PubMed and Embase. Eligible studies included RCTs/cohort studies published 2020-2025 that investigated postnatal calcium, phosphate, vitamin D supplementation, or physiotherapy in preterm infants (<37 weeks), while recognising that the highest MBDP burden occurs in infants born <32 weeks or with very low birth weight and that selected moderate-to-late preterm infants may remain vulnerable when additional nutritional or clinical risk factors are present. Studies were screened with Covidence, and relevant data were qualitatively synthesized by intervention type and outcomes. RESULTS: From a total of 942 records initially identified, sixteen studies were included (eleven supplementation, five physiotherapy). Higher-dose calcium and organic phosphate, especially when administered continuously, improved biochemical and radiological outcomes. High-dose vitamin D offered no benefit over standard dosing, but individualized monitoring improved safety. Limited evidence demonstrated that active or reflex-based physiotherapy improved bone density and growth but with some concerns for safety; passive approaches had limited effect. CONCLUSION: Continuous high-dose calcium and organic phosphate are particularly beneficial. Standardized diagnostic criteria for biochemical and radiological MBDP assessment are needed, as the absence of consensus disease definitions remains a major barrier to interstudy comparability, evidence synthesis, and the development of clinical intervention protocols. REGISTRATION: This systematic review was prospectively registered with PROSPERO (CRD420251116486).
UNLABELLED: Pulmonary hypertension (PH) confers significant morbidity and mortality in infants. Risk limits utilization of cardiac catheterization for diagnosis. Pulmonary-artery-acceleration-time (PAAT) and eccentricity...UNLABELLED: Pulmonary hypertension (PH) confers significant morbidity and mortality in infants. Risk limits utilization of cardiac catheterization for diagnosis. Pulmonary-artery-acceleration-time (PAAT) and eccentricity-index (EI) are echocardiographically-measured surrogates in adults but data in infants is limited. OBJECTIVE: Evaluate the association of PAAT and EI with catheterization-derived hemodynamic measurements in infants without structural heart disease. METHODS: This retrospective review included 30 cardiac catheterization studies performed in infants. Echocardiograms performed within one month of catheterization were reviewed. Multiple linear regression and agreement analyses were conducted between catheterization and echocardiographic data for the presence and severity of PH. RESULTS: PAAT was significantly associated with mean pulmonary artery pressure (r-square = 0.34, p < 0.003) and pulmonary vascular resistance (r-square = 0.21, p < 0.039). EI was not associated. Agreement of severity of PH by echocardiographic and catheterization data was fair (kappa = 0.29). CONCLUSIONS: In infants, PAAT is associated with invasive hemodynamic measurements, while EI is not associated. These measures do not improve upon other echocardiogram-derived estimates of PH.
OBJECTIVE: To explore differences in human milk hormones with metabolic conditions (obesity and/or diabetes) during pregnancy and the relationship with infant adiposity. STUDY DESIGN: In a prospective cohort of term and...OBJECTIVE: To explore differences in human milk hormones with metabolic conditions (obesity and/or diabetes) during pregnancy and the relationship with infant adiposity. STUDY DESIGN: In a prospective cohort of term and preterm infants, hormones were measured in early human milk, and growth was assessed at discharge. Differences in hormones by metabolic conditions and the relationship with growth were modeled using quantile and linear regression. RESULT: Among 38 infants (mean gestational age 35.2 weeks), 50% were in the metabolic-group. Milk leptin was higher in the metabolic-group, with median difference 427 pg/mL (95% CI: 3.2, 850.9). After adjustment for exposure to maternal milk, each 10-fold change in leptin related to 2.1 cm (95% CI: 0.3, 4.2) increase in abdominal circumference and each 10-fold change in insulin related to 1.1 cm (95% CI: 0.03, 2.1) increase in mid-arm circumference, while other effects were attenuated. CONCLUSION: In this explorative study, leptin was higher in human milk from women with metabolic conditions, and human milk hormones predicted growth at discharge.
Chronic pulmonary hypertension (cPH) associated with bronchopulmonary dysplasia (BPD) remains a major contributor to morbidity and mortality among preterm infants. Systematic screening enables earlier diagnosis, improves...Chronic pulmonary hypertension (cPH) associated with bronchopulmonary dysplasia (BPD) remains a major contributor to morbidity and mortality among preterm infants. Systematic screening enables earlier diagnosis, improves recognition of disease heterogeneity, and supports development of targeted management strategies. However, existing screening approaches vary and often emphasize treatment considerations without adequately distinguishing underlying hemodynamic phenotypes, including pulmonary vascular remodeling, systemic-to-pulmonary shunting with increased pulmonary blood flow, and left heart disease. This lack of mechanistic differentiation may delay appropriate therapy and expose infants to ineffective or harmful interventions. There is a critical need for standardized screening strategies that integrate physiologic phenotyping to better define disease contributors, severity, and longitudinal risk. The physiology of cPH is dynamic and changes over time. In this perspective, we propose a phenotype-integrated screening algorithm in BPD-associated cPH, focusing on identification of high-risk populations, optimal timing and modality of assessment, phenotype-directed management pathways, longitudinal follow-up, and coordinated multidisciplinary care.
OBJECTIVE: To describe one-year post-discharge outcomes of infants discharged with nasogastric (NGT) feeding. STUDY DESIGN: Retrospective cohort analysis including infants (0-3 months) born or admitted to a single tertia...OBJECTIVE: To describe one-year post-discharge outcomes of infants discharged with nasogastric (NGT) feeding. STUDY DESIGN: Retrospective cohort analysis including infants (0-3 months) born or admitted to a single tertiary children's hospital (April 2014-December 2022) and discharged with NGT feeding. Data analyzed included demographic and clinical characteristics and outcomes at one-year post-discharge. Subgroup analysis compared infants who required GT placement within one-year and those who did not. RESULTS: 121 infants were included. Median gestational age was 38 weeks. Most infants achieved full oral feeding at one-year post- discharge without GT placement (n = 103, 80%). Median duration of NGT use was 21 days. For those requiring a GT, the median time from discharge to placement was 61 days. Infants discharged with an NGT who did not require a GT were readmitted less frequently (p-value < 0.001). CONCLUSIONS: Infants discharged with an NGT had positive outcomes at one-year post-discharge with infrequent need for eventual GT placement or readmission.
OBJECTIVE: Compare the direct antiglobulin test (DAT) versus end-tidal carbon monoxide (ETCOc) to predict significant hyperbilirubinemia. STUDY DESIGN: Prospective review of a convenience sample of 151 newborns admitted...OBJECTIVE: Compare the direct antiglobulin test (DAT) versus end-tidal carbon monoxide (ETCOc) to predict significant hyperbilirubinemia. STUDY DESIGN: Prospective review of a convenience sample of 151 newborns admitted to the newborn nursery who had ETCOc testing in addition to standard of care (including DAT for those with ABO incompatibility). RESULTS: The optimal ETCOc cutoff to predict a serum bilirubin meeting the neurotoxicity risk phototherapy threshold was 2.1 ppm. DAT had a sensitivity of 13% with specificity of 89% and ETCOc ≥ 2.1 ppm had a sensitivity of 88% with specificity of 68% to predict this outcome. Use of ETCOc ≥ 2.1 ppm rather than DAT to determine neurotoxicity risk increased indications for serum bilirubin testing (25% versus 18%) and phototherapy (8% versus 1%). CONCLUSION: ETCOc ≥ 2.1 ppm had higher sensitivity but lower specificity than DAT to predict hyperbilirubinemia and resulted in increased indications for serum bilirubin testing and phototherapy.
Davis TJ, Akangire G, Brei BK
… +13 more, Coyle M, DiPrisco B, DuPont T, Gage S, Hanin M, House M, Lai K, Miller AN, Rana D, Rao K, Ransom MA, Sillers L, DeMauro SB
BACKGROUND/OBJECTIVES: To characterize sedative and analgesic use in NICU patients with grade 3 bronchopulmonary dysplasia (BPD) in relation to respiratory support and neurodevelopmental therapies. SUBJECTS/METHODS: Poin...BACKGROUND/OBJECTIVES: To characterize sedative and analgesic use in NICU patients with grade 3 bronchopulmonary dysplasia (BPD) in relation to respiratory support and neurodevelopmental therapies. SUBJECTS/METHODS: Point-prevalence survey across 22 NICUs of infants <24 months corrected age with grade 3 BPD who had never been discharged. Exclusions included recent sepsis, tracheostomy, or major surgery. Data were analyzed descriptively. RESULTS: Among 141 infants, 97 (69%) received ≥1 sedative within 48 hours; 73 (75%) received multiple (mean 2.8 ± 1.6). Alpha-agonizts (n=67) and benzodiazepines (n=65) were most common, with 27 infants receiving an alpha-agonist, opioid, and benzodiazepine combination. Sedative exposure and medication count correlated with higher respiratory support (p<0.001) and FiO₂ (r=0.28, p<0.01). Sedation was associated with fewer completed therapy sessions (z=3.3, p<0.001). CONCLUSION: Sedation and polypharmacy were frequent among infants with severe BPD and linked to reduced therapy participation, highlighting the need to assess prescribing rationale and neurodevelopmental impacts.
A complete blood cell count (CBC) characterizes the cellular components of blood. It is one of the most frequently performed blood tests of hospitalized patients, including infants in a NICU. We quantified the percentage...A complete blood cell count (CBC) characterizes the cellular components of blood. It is one of the most frequently performed blood tests of hospitalized patients, including infants in a NICU. We quantified the percentage of Intermountain Health NICU patients who, during the past ten years, had a CBC drawn at birth or within the first two hours thereafter. The percentage progressively dropped annually, from 54% in 2016 to 13% in 2025. We authored this Perspective, (1) to review the array of diagnostic information that can be gained by a CBC at NICU admission, and (2) to emphasize that the initial CBC can be drawn from otherwise discarded fetal blood in the umbilical cord. Using that method avoids the blood volume reduction, and the pain, associated with infant phlebotomy. We hope these reminders support NICU providers in making informed decisions about ordering a CBC at birth.
OBJECTIVE: We aimed to determine whether clinical variables predict the success of extubation for premature infants. STUDY DESIGN: Using variables preceding 320 extubations of infants ≤30 weeks or ≤1250 g at birth, we bu...OBJECTIVE: We aimed to determine whether clinical variables predict the success of extubation for premature infants. STUDY DESIGN: Using variables preceding 320 extubations of infants ≤30 weeks or ≤1250 g at birth, we built predictive models for success at 1-, 3-, and 7-days using machine learning algorithms. We also determined whether lung ultrasound (LUS) scores (n = 15) were associated with success, or predicted success, of extubation. RESULT: Of 84 factors considered, nine were associated with success at 1 day, seven at 3 days, and six at 7 days. The accuracies of the predictive models were 78-84%. Median LUS scores were significantly lower preceding successful extubations (at 3 days) but not correlated with the findings of the predictive models. CONCLUSION: We devised robust models for predicting extubation success based on clinical antecedents. Further study is needed to determine whether LUS can further improve prediction of extubation readiness.
OBJECTIVE: Our primary objective was to determine whether brief, as-needed interprofessional meetings reduced distress related to specific patient cases for interprofessional clinicians in the neonatal intensive care uni...OBJECTIVE: Our primary objective was to determine whether brief, as-needed interprofessional meetings reduced distress related to specific patient cases for interprofessional clinicians in the neonatal intensive care unit. STUDY DESIGN: We collected pre- and post-meeting surveys to quantify clinicians' distress. RESULT: We collected 416 paired responses (80% participation rate) from 192 unique clinicians. RESULTS: After meetings, clinicians reported reduced intensity of most distressing thoughts; they were more likely to feel their perspective was heard (1.51 to 1.17, SD 0.82, p < 0.001), the team was united (1.56 to 1.22, SD 0.84, p < 0.001), they could provide good care (1.76 to 1.62, SD 0.98, p < 0.001), and that the rationale for care was reasonable (1.93 to 1.52, SD 0.93, p < 0.001). Moral distress was also lower on post assessments (5.47 to 5.27, SD 2.55, p = 0.005). CONCLUSIONS: Brief, as-needed interprofessional meetings decreased distressing thoughts about challenging cases, particularly for those experiencing the greatest distress.